Dismissal Meeting Term Paper Example | Topics and Well Written Essays - 1250 words

Dismissal Meeting - Term Paper Example Stewart & Brown (2008) outlines that the manager must keep himself prepared to deal with the expected negative emotional reactions. The supervisor or manager can award the employee with a generous compensation package (Kinicki & Williams 2009). The package could offer the employee economic benefits to reflect on the point that the management understands and is compassionate of the dismissal’s impact. Secondly, the company or manager should make an effort to find another job for the dismissed employee. This could mean researching with colleagues, business partners or friend to check if there is any recruitment taking place or if there are any openings (Holihan, 2006). In addition to this effort, the manager or the company should cover the expenses for the employee’s career counseling and provide an on-site resume writing training to the employee. This can cause loyalty from the employee being laid off (Stewart & Brown 2008). Third, the employer should fund a psychological counseling to the employee (Kinicki & Williams 2009). Many employment consultants outline that those who have lost their employment or jobs experience difficult stages of grieving. The psychologist Elisabeth Kubler-Ross stated that freshly laid off individuals experience a wave of emotions that run from anger to shock and denial, bargaining, stress, depression and finally acceptance (Holihan, 2006). Such stages need psychological counseling. The manager can offer, in agreement with the company, to fund such processes. According to Holihan (2006), prior to the meeting, the manager must provide the employee with a notification. The employee must have prior information of that there is a meeting. However, the manager shouldn’t give information of the meeting before the actual meeting is held. Second, the manager should set up a meeting. A face to face meeting with the employee is often preferred (Stewart & Brown 2008). Dismissal should never be communicated over the phone, by email or

Budget Proposal Essay Example | Topics and Well Written Essays - 1250 words

Budget Proposal - Essay Example (Womack, 2009) Indeed, it is justified to argue that performance of department is fairly lower than police agencies in other US states and cities. Our department does not have enough personnel as only fewer than 250 employees are on job against announced vacancies of 310. Hence, the police officials are unable to share various law enforcement responsibilities and fulfill their duties that are assigned by Department Head and state authorities. This in turn leads to extreme work overload over existing officers thereby resulting in mental stress and reduction in performance and efficiency. In addition, the employees’ morale has reduced because of comparatively low wages at Macon Police Department against other area departments including ‘Bibb County Sheriff’s Office and The Medical Center of Central Georgia’. Similarly, there are also fewer chances for officers to attain extrinsic financial rewards (bonuses, pay increase etc) and promotions. Together, these factors demotiva te the police officers and compel to either switch their jobs or showcase low performance. Turnover rates may also increase in future if the above two factors are not rectified. (Womack, 2009) As far as internal efficiency of Macon Police is concerned, it should be pointed out that officers have been using old vehicles (that require immediate maintenance and repair) with out dated in-car cameras. Similarly, department also does not have any modernized computer equipments, information systems and technology that could help in record keeping of crimes, immediate information access and in crime investigation. In order to improve department’s overall performance in the light of above mentioned analysis of problems, there is dire need to improve job pay scale and employee promotional system so that officers’ morale, confidence and commitment with their job could be increased. As a result,

Nursing Shortage in the United States

Nursing Shortage in the United States NURSING LABOUR FORCE IN THE U.S. HEALTH CARE SYSTEM Abstract The well-anticipated demographic change attributed to the ageing of the baby boomer population in the USA will led to a significant demand on the healthcare industry in the long run. Important resources such as the nurse work force will be required to provide quality health care services to the population. This research paper will provide a brief description and statistics of the nurse labor force in the USA, the educational requirement needed to be a nurse, the challenges face by the nurses in the healthcare system. The last part of the paper identifies the nursing shortage and the solutions for the short and long run, the recommendations and finally, the conclusion. LABOR FORCE IN THE U.S. HEALTHCARE SYSTEM The healthcare system in America is a complex and unique setting comparing to the other 34 countries in the Organization for Economic Co-Operation and Development (OECD). In 2016, The United States spent $3.3 trillion on health care benefits, or 10,348 per person annually, which represents17.9 % of the total GDP and remained at top of all OECD countries for the healthcare expenditures. About 30% of the cost was spent on hospital care, 20% on physician and clinical services, 10% on prescription drugs and 5% on nursing care. However, the life expectancy is 78.6 years which ranked 22nd of the OECD countries (Medicare & Services, 2015). Meanwhile, problems such as growing population, aging and shortage of physicians and nurses are causing the increasing demand for healthcare benefits (Levit & Patlak, 2009). In 2016, there were 5,534 registered hospitals including 4,840 community hospitals in the U.S, most of the healthcare facilities are owned by private companies and 60% of the community hospitals are non-for-profit organizations, 20% are for-profit and 20% are owned by government. In U.S, the most value of healthcare system in America is the health professional, also considered as health providers (AHA, 2018). THE NURSING WORKFORCE According to U.S Bureau of Labor (2018), the total labor force was around 160 million. Nurses are playing an important role in the healthcare system. Nursing demographic consists of: 1.5 million certified nursing assistant (CNA), which represents about 1% of the U.S labor force who are responsible supporting patients’ daily activities such as taking vital signs, dispensing prescribed medications, bathing and transporting patients. Certified nursing assistant is concerned as nursing assistant as general or patient care assistant. CNA is like medical assistants that both assist physicians, nurses and such healthcare providers. Usually, CNAs are assigned in an inpatient hospital and residential facilities such as nursing home and day care centers. Till 2016, the average salary for CNA was $26,590 while VA hospitals might offer better salary, around $37,450. Alaska pays the highest average salary which was $17.81/hour while it was $11.6/ hour in West Virginia. In fact, the market expected the demand for CNAs would increase about 11% during 2014 to 2024. 738,000 licensed practical nurse (LPN), which represents about 0.5% of U.S labor force, who are responsible for administering injections, surgical preparation and communication between patients and physicians. LPNs also do assistant works such as recording and maintaining communication with patients, registered nurses and physicians. LPNs are directly assigned to take care of patients that keep patients comfortable. Sometime, LPNs are assigned to take blood pressure, insert catheters and such activities. LPNs usually work in hospitals, nursing homes, doctor’s offices and any healthcare facilities. In fact, LPNs are the direct contact between patients and physician that they are responsible for keep patients’ knowledge about treatment and procedures. The average salary for an LPN was $44,000 and the number is expected to increase. Connecticut state pays the highest average salary which was 24.30/ hour, comparing to the lowest paying state West Virginia with $14.25/ hour or $29,640 per year. 3 million registered nurse (RN), which represents the largest group of all types of nu rse and 1.9% of U.S labor force, who are qualified with license to make nursing diagnoses and work as a supervisor of CNAs and LPNs. RNs work with physician and healthcare teams to improve healthcare quality and treatment quality. RNs also educate patients for their health conditions and support patients and their family members on further living. Since it is the largest group, the competition is fierce. Depending on the specialty, education and experience, the average salary was around $70,000 in 2015. Some hospitals might offer better payment to $100,000. California owns the largest number of RNs, which was around 300,000 and it pays the highest salary in America, which was $98,400 on average. The market expected a 16% increase of RNs from 2014 to 2024.151,000 advanced registered nurse practitioner (ARNP), who received additional education with master’s degree or post graduate degree and additional medical experience. ARNPs work as clinical nurse specialist and nurse anesth etists that they are certified to diagnose, prescribe medication and therapy, provide treatment and counsel to patients. ARNPs are specify into multiple types such as acute care, nursing information, nurse administrator, travel nursing, family nursing, psychiatric nurse, neonatal nurse and pediatric nurse. The average wages for ARNPs was $95,000 or $46.40/ hour. During the first decade of 21st century, the job opportunities in the healthcare segment of United States grew with a pace of 20% while, in all other segments of the industries nationwide, the same growth was merely 3%. The growth rate has boomed in the US healthcare market, demanding for more and more registered nurses and nursing professionals in the current decade as well. These opportunities have created various job profiles so far in the evolving hospital settings. New hospitals and home care-based jobs are also emerging rapidly. â€Å"It is anticipated that the rate of employment in the health care sector will grow faster than the rate of employment in all other sectors between 2014 and 2024, with projected increases of nearly 22% and 5%, respectively. Other service sectors are projected to grow by about 8% during the same time period .†Ã‚  (Martiniano, Chorost, & Moore, 2017). Currently there are more than six million of the staff available across states in the healthcare settings for RNs and NPs working in various administrative positions in United States. The growth rate is also having positive rays of hopes in terms of having future job employments because of the fact that between 2014 to 2024, it is estimated that the home care based jobs are expected to increase by 60% while jobs in the offices of the healthcare practitioners are also said to have the increase of 25% because as of now, there are more than 4 million of jobs that are available in the same position—the job positions are subjected to be vacant and filled at the same time, depending on the conditions of the nurses who are employed and leave their jobs due to unforeseen conditions (Martiniano et al., 2017). Researches showed that there would be a 1 million shortage of RN in 2020 because of the dropping economic situation in America. In fact, the shortage has been ongoing since 1998 that it has been always a lack of supply. The supply was higher than the increase of demand. There were several reasons behind the shortage. Ageing of nurses might be the most concerned issue in recent that many nursing practitioners are getting older. Since 2012, the 50-60 year-age group represented the largest group on RNs and these group is expected to retire before 2025 but they are the ones who are the most experienced for taking care of patients (Levit & Patlak, 2009).   The U.S government also supports foreign-born nurses in order to fill the gap between supply and demand. In 2008, international nurses represented 15% of the nursing workforce. One concern was the communication that international nurses might have problems on communicating with patients and doctors even thought they had passed the English language test such as TOEFL and IELTS. In fact, foreign-born nurses on average cost less than American born nurses and they contribute extra value on international patients (Levit & Patlak, 2009). NURSING PROFESSION’S QUALIFICATION With the expansion of the ACA, allowing more people access to health care and insurance coverage, and the aging of the population, which increases the nationwide rate of terminal illnesses such as heart failure and cancer, the demand for care is higher than ever and there prompts the big question of whether the current health care workforce can adequately meet that demand. To fill the obvious gap that will occur, non-physician providers will be needed. Potential candidates for the positions are no other than advanced trained nurse. In the1990s, funding for nursing education drew the attention of policymakers as people realized there would be substantial shortfalls of nurses in the next decades. Efforts to increase funding for nursing education have been intermingled with advocacy for increased emphasis on baccalaureate entry-level education. In the past, many RNS were educated in hospital-based diploma programs, but most of these programs has been converted to associate or bachelor’s degree programs. The shift in nursing education from hospitals to universities marked the importance of the body of knowledge that the nursing profession should possesses. More essentially, it defined nursing as something much more than assistant to the physician. As an effort to alleviate a looming cycle of nursing shortage, community colleges and technical schools started offering nursing program in the 1970s. Since then, the nursing education has greatly evolved to better prepare their students for the ever-changing and challenging world of health care system. The two most common paths for people pursuing a nursing degree is either obtaining a 2-year associate degree (AND) or a 4-year baccalaureate program (BSN). Many community and technical colleges offer ADN programs and they are more attractive to prospective nurses because of their affordability and a shorter time period to finish. Graduates from the programs are qualified to sit for the National Council Licensure Examination for Registered Nurse (NCLEX-RN). This type of program provides a solid foundation for entry-level nursing positions at a wide array of health-related establishments, including hospitals, primary care clinics, and nursing homes. In addition, nurses can later register for the RN-to-BSN bridge programs to obtain their BSN. The 4-year BSN, while more time consuming, opens up more opportunities for nursing students upon their graduation. BSN candidates receive intensive training not only in the clinical field, but also in leadership and communication skill. The goal is to provide more professional development to their students through a comprehensive curriculum that covers some of the most pressing issues within the profession, such as public health, social sciences, nursing research, and management and leadership. Most of nursing programs are not recommended to be taken online as they are hands-on profession. Averagely, nursing program costs $15,000 per academic year (Registered Nursing Degrees, 2018). In the 1990s, nurses once passed their board licensing received the same licenses and often hired to perform the same jobs. Their background education, whether they had an associate degree (ADN) or a baccalaureate degree in nursing (BSN), did not differentiate the task they performed in any health care facility. While the practices and educational differences between ADN and BSN were proven to exist, there was a general but often weak correlation in patient outcomes based on the initial education preparation of the RN providing the care (Kovner & Schore, 1998). A meta-analysis done in 1988 by Joyce Johnson pointed out that BSN RNs attained higher scores in the field of communication, problem solving, and professional role when compared with AND RNs. Contrariwise, these associations decreased when experience was taken into account, and no distinguishing result existed in measuring level of leadership and autonomy between BSN and ADN RNs.  Time has changed and so as the complexity of the health care system. The role expectations and educational outcome differences for ADN and BSN has been more clarified. Although the health care system required nurses prepared at both levels of education, the graduates of these programs hold different competencies and should be valued for those differences (N/A, 1995). A study done in 2003 further proved this notion by showing the connection between higher levels of nursing human capital and improvement in patient outcomes – a 10 percent increase in nurses with baccalaureate degree yielded a 5 percent decrease in patient mortality and complications (Kutney-Lee, Sloane, & Aiken, 2013). This clarification in the roles of ADN and BSN nurses are vital to the delivery of high quality care and require the restructure of their education curriculum as well as validation in the systems in which these graduates are employed.      ISSUES IN THE NURSING LABOR FORCE Like many other health care professional, the nursing workforce has many problematic areas that need to be resolved. One of the most pressing one is the shortage in labor force. The Patient Protection and Affordable Care Act (ACA) since its enactment in March, 2010, has successfully provided insurance coverage for around 19.2 million people and dropped the number of uninsured population from 20.5 percent to 12.2 percent in 2016 (Garrett & Gangopadhyaya, 2016). This influx of new patients has driven up the demand for nurses with the U.S. Department of health and Human Services projected a shortfall of over one million nurses by 2020 (DHHR, Resources, Workforce, & Analysis, 2017). However, the current state of the workforce is gradually depreciated due to several factors. The aging baby boomer nurses reaching their retirement ages contributes as the first factor in this shortage crisis. This aging workforce has been dealing with increasing pressure due to higher work demand resulted fr om nursing shortages, and their health suffers tremendously with a significant higher number of senior nurses experiencing chronic pain, tiredness, and exhaustion among the group (Gabrielle, Mannix, & Jackson, 2008). An obvious fix to this problem is to increase the number of qualified nurses in the labor market through nursing school recruitment campaign. Unfortunately, the majority of nursing schools nationwide do not have the capacity to accept new candidates due to a lack of faculty, budget constraints and limited clinical sites for students to practice. While all schools reported reaching their full capacity and even going over their students limit each year, many applicants got rejected, with 78 percent of ADN applicants and 62 percent of BSN candidates, all of them had qualified credentials, were turned away from nursing school in 2016 (Nursing, 2016). This would directly reduce the chance to generate enough nursing graduates to meet the upcoming demands facing the health car e industry. Beside the restricted nursing enrollment rate, health care providers only preferred nurses who already had several years of experience and turned down many potential applicants only because they newly graduated. Another realistic alternative to fill the gap in nursing staff is by hiring foreign-educated nurses. However this solution is poorly received since it stirs up concerns regarding the level of competency of nurses trained outside the U.S. and immigration issues (Williams, 2014). A shortage of nurse will ultimately lead to a change of nurse staffing pattern in care centers, with one nurse tending for more patients. A study by Cummings and Estabrooks (2003) pointed out the negative effects the change in nurse staffing patterns had brought upon the remaining nursing staffs’ health and their competency to provide quality care. Other research literature also reported imbalance nurse staffing pattern can drive up the rate of preventable medical errors and adverse events (e.g. hospital-acquired pressure ulcers, wrong blood transfusion) (Cho, Ketefian, Barkauskas, & Smith, 2003). The predominant effects of hospital restructuring on nurses are mostly negative with a decrease in efficacy and ability to provide quality care, reduction in job satisfaction, and disparity in teamwork among care providers, which resulted in an increase in turnover rate. Cost containment initiatives in many health care establishment can also further deplete the nursing workforce. The U.S. health care expenditure has skyrocketed over the past decade and accounted for 17.9 percent in the overall share of gross domestic product (GDP) and more than $10,000 per capita in 2016 (Llanos & Rothstein, 2007) (CMS, 2016). Regardless, the U.S. index for health care outcomes such as life expectancy, maternal mortality, child and infant mortality are far behind other OECD nations (Institute of Medicine, 2007). As a result, several health reform programs were introduced in an attempt to increase access-to-care for the population, reduce the health care cost, and improve the quality of health care. The implementation of these pilot programs put tremendous pressure on health care providers and organizations to contain their cost while maintaining optimum treatment to their patients. Many care facilities decided to restructure their workforce by decreasing the overall labor pool. As one of the largest personnel group in the health care workforce and oftentimes claimed for the largest piece of the hospital budget pie, approximately 33 percent of hospital operation cost (Walston, Burns, & Kimberly, 2000), nursing positions were the primary target for cost-containment strategies in many organization. The result was an increase in substitution for lower credential nursing position, such as Licensed Practical Nurse which only required two years of associate degrees, or even unlicensed personnel like patient-care technicians. This shift in work force in the 1990s, however, had driven up the rate of medication errors, patient injuries and infection (Kunen, 2001). To better adapt to the ever changing environment of health care bureaucracy and population health priorities with finite capital and human resources, all health-related establishments should develop strategies with emphasis in organization and culture restructure that has positive impact on the outcomes of patients and nurses. Beside financial incentives, political advocacy from both the federal and state government, as well as professional opinion and standard setting can further make changes to the recruitment and retention of qualified nurse workforce. THE GOVERNMENT’S EFFORT IN SOLVING THE ISSUE OF NURSE SUPPLY One of the problems the healthcare system in the U.S. is facing is that of shortage of nurses. Some factors which contribute to this shortage is the fact that women have more options in choosing their career path in society today when compared to the past. From an economic point of view, this problem of shortage is cause more by the supply side rather than the demand side thus, making it a more complex shortage (B. & J.I., 2001). This shortage of nurses might worsen in the long run if the government do not develop and implement solutions to solve this problem. Some economic solutions where developed in the past to help solve this problem such as relocation coverage, new premium packages and sign on bonuses; however, they were all short-term solutions which helped in redistributing the supply of nurses instead of increasing it (B. & J.I., 2001). Due to the shortage of nurses in the healthcare system, the government has developed and implemented solutions which will be examined below. The government is trying to recruit more students and educators in the nursing field to combat with the increasing demand in the workforce. For some years now, recruitment of students in the school of nursing has been declining. According to the American Association of College of Nursing, the number of nursing students who enrolled in the bachelor’s degree program had been declining in the past five years (Larson, 2016). In 1999, the number of nursing students felt by 4.6% nationwide. Nursing master program also suffered the same fate with a decline of 1.9% in some states (Larson, 2016). To better utilize the current aging workforce, healthcare circles decided to recruit the old and retired practicing nurses who can no longer administer treatment to the growing population and appointed teaching positions to them in nursing schools. They came to a conclusion that this ageing nurse’s will better teach the students as they are teaching out of experienced and it is said exp erienced is the best teacher (Johnson et al., 2006). Practice and experience are two important factors that teachers most acquired in order to teach students effectively. Also, in San Diego, six hospitals donated $ 1.3 million to support a program known as â€Å"Nurses Now†, which will be an opportunity to add faculty members and additional nursing students in the San Diego University (Costantini, 2016). Moreover, in order to support students to do nursing, the Texas hospital donated $ 425,000 in scholarships to local students to do their bachelor’s degree program in nursing. Moreover, in New Jersey the Board of Free holders donated scholarships to local students who accepted to work in the long term care facility in the USA (Costantini, 2016). These are examples of some successful collaborative efforts between healthcare organizations, nursing schools and the USA government to help solved the problem of nursing shortage in the USA. Moreover, in order to solve to problem of shortage, hospitals are re-implementing intensive training programs for nurses in various specialities. This has gone a long way to retain nurses who are seeking for a transfer and has also help build a vocation development path for nursing staff. A research that has been done on Magnet hospitals indicate that some of the organizational characteristics that create a centre of attention and retain nurses are professional practice models for delivery of healthcare with independence and responsibility to make decisions (B. & J.I., 2001). Moreover, effective managerial structure, quality patient services and investment in nurses’ professional development in the healthcare system are very necessary and important. Nurses must be involved in developing and implementing the practice of care in hospitals since they are very close to patients. Some of this practise includes; participating in the financial management of the hospital and developin g new strategies in hospitals. If healthcare leaders developed intensive programs for nurses in each specialities, it will motivate them to realize that they are very important in the healthcare system thus, encouraging them to remain in their various specialities in nursing. Furthermore, healthcare leaders need to developed models of care in order to solve the problem of nurses shortage in the USA, the government need to implement regulatory and policy issues (Johnson et al., 2006). Some regulatory and policy problems could also cause the nursing shortage such as federal and state laws, licensure and nursing practice act, and requirements from reimbursement organizations, private organization and the government (Johnson et al., 2006). Inside an organization, insistent process developments initiatives can assist standardize and simplify documentation. Healthcare leaders should drive this problem with some consultation from some internal experts in reimbursement, patient documentation and risk management. Furthermore, nursing trainers should use technology as one of the training tool.  Although most of the section in nursing learning is clinical experience, most of the classroom teaching can be done through the new technology we have today such as internet teaching, distance education, and accelerated educational programs.  As the healthcare of patients become more associated to technological improvement, routine nursing performance can drilled by utilizing the same technology. Technology improvement could also be use to test and certified nursing educators (Larson, 2016). All these new methods of teaching nurses through technology advancement will motivate younger adults who like using the internet and other forms of technology to learn to join the nursing field thus, helping to solve the problem of nursing shortage. In addition, to help solve the problem of nurse shortage in the USA, healthcare leaders should concentrate on training our own nursing and retaining them from traveling to other countries such as Canada. One good approach to solve this problem is to employ bachelors and masters students who are already in the faculty programs and provide them with qualified training and prepared them as well-trained nurses to be employ in the nursing field (Buchan & Aiken, 2008). Guidance into the clinical faculty is one of the best in this context, and this will improve nursing student’s capacity to do their work in the nursing field efficiently. The main idea is to guide them to grow into the nursing profession and eventually make nursing their profession of choice. This strategy will work well to the nursing field advantage because, it will encourage students to choose nursing as a career thus, increasing the number of nurses for the future. To continue, to solve the problem of nursing shortage in the USA, the government should augment the supply of nurses by using tax credit. For example, three bills where pass to permit the creation of refundable tax credit for all register nurses (Johnson, Posner, Biermann & Cordero, 2006). This is a positive impact that would have help retain nurses in the profession and it will also help to increase their salaries. Moreover, it will motivate them to maintain their various positions in hospitals thus, working positively in reducing the problem of nurse shortage in the USA. More so, in order to solve the problem of nursing shortage in the USA, hospital managers should offer bonuses to nurses who accept and sign up to work in that hospital for a long period of time. For example, in St. Paul hospital in Minnesota, the hospital leaders are giving out bonuses of about $8,000-$10,000 to nurses with essential care experience who have sign up to work in the hospital for a long period (Larson, 2016). This strategy has help St. Paul hospital to keep most of it nurses. If more hospitals could adopt this method, it will help solve the problem of nurse’s shortage in the USA. Moreover, in order to solve the problem of nurse shortage in the USA, the government need to increase the salaries of nurses. The work load of nurse’s especially register nurses is much as they are the ones who spend most of the time taking care of patients (B. & J.I., 2001). Most of them leave the nursing field because they are not well pay for the work they do and most of the time, some are not pay for the extra work they do. In order to solve this problem, the USA government has increased the salary of nurses for example in California; the salary of register nurses went up to $94, 120 per year (B. & J.I., 2001). This has motivated many people to join the nursing field. According to experts’ projections from the Bureau of Labour Statistics, by 2022, the nursing field will experience an increase in the number of register nurses of about 526,800 (B. & J.I., 2001). This is a good sign for the healthcare field for the future – absolutely a field with good prospects . ALTERNATIVES FOR THE SHORTAGE IN NURSING SUPPY Nurses form an essential part of the working force in the healthcare system in the USA and the great role they play cannot be ignored. This explain why the USA government, over the years have been trying to solve the problems nurses are facing in the healthcare system in order to motivate more people to join the nursing field. Due to all this, some recommendations are made to help improve the nursing working force. One of the recommendations is that, healthcare leaders should change consumers’ knowledge of healthcare services. Most patients like meeting register nurse for them to take care of them whereas; they are other nurses in the hospital who can take care of them better. Healthcare leaders’ need to change this perception some patients have concerning the choice of nurses. More so, some patients believe that nurses who are well paid do the work better than nurses who are less pay. That is why patients keep traveling from one state to another in order to seek for hospitals where nurses are been well pay. For example, most Americans travel to big states such as California in order to receive treatment from physicians and nurses. This believes is not good because it creates nurses shortage in big states compare to small states (Costantini, 2016). The USA government should develop and implement public health programs that will help educate the population on how to prevent certain illnesses. This will help reduced the number of people who get sick, thus reducing the number of patients, nurses have to take care of. People should do more of physical activities and eat healthy in order to avoid unnecessary illnesses which could be avoided by doing this. Also, the population should be sensitize about the problem of nursing shortage in the country. This will motivate them to take good care of themselves in order to avoid falling sick. Based on the execution of these recommendations, it will assist to achieve healthy people 2020 objectives. These recommendations are strategic plans that can be utilize by the government, people, private and public health providers and communities to improve the health of the population thus making the USA government to achieve its goal of healthy people 2020. CONCLUSION Nurses play a very significant role in providing medical treatment to patients and they also help to re-enforce the physician’s shortage labour force in the USA. Many health care organizations can not do with out nurses as they play a significant role. If the shortage of nurses worsens, many patients will no longer have access to care thus, creating a huge problem in the country. The USA government need to take the problem of nursing shortage in the country very serious as the baby boomer nurses retirement will cause a serious shortage. With the fast growing population of America, as many immigrants are coming in, it is necessary for the USA government to attract more nurses into the health care system. It there is surplus of nurses in the country, it will help the government, Medicare & Medicaid and other health organizations contain healthcare cost which is very expensive. It will also increase quality and access to medical care. REFERENCES B., N., & J.I., E. (2001). The nursing shortage: solutions for the short and long term. Online Journal of Issues in Nursing, 6(1), 4. Cho, S.-H., Ketefian, S., Barkauskas, V. H., & Smith, D. G. (2003). The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nursing Research, 52(2). CMS. (2016). National Health Expenditure Data. Retrieved from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html Costantini, S. D. (2016). Challenged by a Nursing Shortage? Consider These Short-Term Solutions and Long-Term Strategies. Avant Healthcare. Retrieved from https://avanthealthcare.com/nursing-shortage-solutions-strategies/ Cummings, G., & Estabrooks, C. A. (2003). The effects of hospital restructuring that included layoffs on individual nurses who remained employed: a systematic review of impact. Journal of Sociology and Social Policy, 8(9). DHHR, Resources, H., Workforce, B. o. H., & Analysis, N. C. f. H. W. (2017). Supply and Demand Projections of the Nursing Workforce: 2014-2030. HRSA Health Workforce. Gabrielle, S., Mannix, J., & Jackson, D. (2008). Older women nurses: Health, ageing concerns and self-care strategies. Journal of Advanced Nursing, 61(3). Garrett, B., & Gangopadhyaya, A. (2016). ACA Implementation Monitoring and Tracking. The Urban Institure, 19. Institute of Medicine, B. o. H. S. (2007). Rewarding Provider performance: Alligning incentives in Medicare. National Academies Press. Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., . . . Curtis, M. G. (2006). Recommendations to Improve Preconception Health and Health Care United States Retrieved from Kovner, C. T., & Schore, J. (1998). Differentitated levels of nursing work force demand. Journal of Professional Nursing, 14(4), 11. Kunen, J. (2001). The New Hands-off Nursing. Kutney-Lee, A., Sloane, D. M., & Aiken, L. (2013). An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Postsurgery Mortality. National Institutes of Health, 32(3). Larson, J. (2016). Creating Solutions to the Nursing Shortage. Retrieved from https://www.americanmobile.com/nursezone/nursing-news/creating-solutions-to-the-nursing-shortage/ Levit, L., & Patlak, M. (2009). Ensuring quality cancer care through the oncology workforce: sustaining care in the 21st century: workshop summary: National Academies Press. Martiniano, R., Chorost, S., & Moore, J. (2017). Health Care Employment Projections, 2014-2024: An Analysis of Bureau of Labor Statistics Projections by Setting and by Occupation. March 2012. In. Medicare, C. f., & Services, M. (2015). National health expenditures 2012 highlights. Published August. N/A. (1995). A Model for Differentiated Nursing Practice. National Organization for Associate Degree Nursing American Association of Colleges of Nursing Nursing, N. L. f. (2016). Percent of Programs that Turned Away Qualified Applicants by Program Type, 2012 † 2016. In. Nln.org: National League for Nursing. Registered Nursing Degrees. (n.d.). Retrieved April 03, 2018, from https://www.allnursingschools.com/registered-nursing/degrees/ Walston, S. L., Burns, L. R., & Kimberly, J. R. (2000). Does reengineering really work? An examination of the context and outcomes of hospital reengineering initiatives. Health Services Research, 34(6). Williams, J. (2014). Implication of Foreign-Educated Nurses on United States Nursing Collegiality. Newyork: Springer Publishing Company.

Ruthless Intentions :: essays research papers

David PagelC.W. 1st hourCorrectionsFiction Story Ruthless IntentionsWall Street, June 18, 1999. A man in dark sunglasses and an expensive sleek Armani suit stands on a gloomy corner waiting. A golden Benz with black tinted windows stops at the curb. Another man dressed in similar attire calmly steps out of the back seat of the car and shots the man on the curb repeatedly. He than just as calmly steps back into the car and the golden Benz darts away in one swift motion.Chicago, June 19, 1999. Mr. Green sits on top of a giant skyscraper in his beautiful executive office. He is smoking a Cuban cigar in his big leather chair with golden trim. The same man who shot the man on the street walks in and takes a seat."The job is done," said the man in a bold voice. Mr. Green does not react. He fills his mouth with smoke, leans forward, blows it into the man's face and than slowly leans back and says, "Then where is the briefcase?""He didn't have it with him," said the man in a shaky voice.""You fool!" screamed Mr. Green."I couldn't help it, he didn't have the briefcase!" retorted the man.Mr. Green replies, "Understand that if you don't have the briefcase in forty- eight hours you are not receiving fifteen percent of the money and I am taking 100 percent of your life."Wall Street, June 17, 1999. A man in dark sunglasses and an expensive Armani suit walks down the street. In his right hand there is a briefcase. His fingers are clenched tightly around the handle.In the shadows lies a poor beggar. The beggar asks the man with the briefcase for some spare change. The man with the briefcase, under his breath replies, "Get a job."The beggar hears this and replies, "What did you say?""Nothing!" says the man with the briefcase. The beggar than takes out a knife and holds it to the man's throat. The beggar grabs the briefcase and takes off down the street. The man darts after him but trips on a dog that is being walked by his owner.Chicago, June 21, 1999. Once again Mr. Green sits in his office smoking a cigar. He took a long look at his diamond laced Rolex watch. In walks the other man who shot he man on the street. He takes a seat with a dark look on his face.

Spirit of Adoption vs. Orphan Spirit

Spirit of Adoption vs. Orphan Spirit Human Needs* Safety Unconditional Love Affirmation Purpose Frost, Jack and Trisha, Shiloh Place Ministries Orphan Orphan – Biblical definition: â€Å"Comfortless one† Living as orphans or comfortless ones is living with unresolved unmet needs – either without a family, or in the midst of a family system. This can be seen in our anxiety levels, and by the unhealthy roles we take on to try and be accepted, loved, and welcome in our own families. There are over 200,000 orphans in the world today The effect of physical Orphanhood in children Vulnerability to confusion, anxiety, depression, and behavioral/psychiatric disorders †¢Failure to thrive and actual physical growth stunted Johnson et al. , (2011) †¢Perceived lack of control leading to feeling of helplessness †¢Ongoing inner longing and hope for love and sense of belonging †¢Pleasure connected to life, love, joy and happiness is numbed Dr. Judith Arndell, Psy. D. †¢Lack of Identity Identity Where does identity come from In the World: Occupation Economic Status Sexual Disease Religion Activity Victim Physical Family Role Past Illness Material thingsJust as children with absent genetic fathers have identity issues, (Terwogt et al. , 2002) so will we without the truth from our heavenly Father about who we are. In the Family of God: â€Å"For as many as are led by the Spirit of God, these are the sons of God. For you did not receive the spirit of bondage again to fear, but you received the Spirit of adoption by whom we cry out, â€Å"Abba Father† Romans 8:14-16 God: The Perfect Parent In Him, we are adopted and can have our needs met †¢ John 14:15-18 â€Å"I will not leave you as orphans, but 14:15will send the Holy Spirit (The Comforter) to be with ou and in you. † †¢ Hosea 14:3 â€Å"In you the orphan finds mercy †¢ Psalm 68:5-6 â€Å"A father to the fatherless, a 68:5defender of widows, is God in His holy dwelling. God sets the lonely in families† ADOPTION â€Å"Huiothesia† (Greek): â€Å"the place and condition of a son given to one to whom it does not naturally belong†; â€Å" To place as sons†. Adoption Legal Permanent Change of name and identity Adoption in the Bible Mephibosheth: David brought him into his own family and treated him as a son 2 Sam 9:1-13 Esther: Adopted and raised by her uncle Esther 2:7 Moses: Adopted by Pharaoh's Daughter in EgyptExodus 2 Adoption begins with Loss Matt. 10:39 †¢ â€Å"The person who tries to preserve his life will lose it, but the person who loses his life for me will preserve it. † John 12:24 †¢ â€Å"Truly, truly, I say to you, unless a grain of wheat falls into the earth and dies, it remains alone; but if it dies, it bears much fruit. Luke 9:23-24 †For whosoever will save his life shall lose it: but whosoever will lose his life for my sake, the same shall save it. † But Offer s New Life 2 Tim 2:11 I rely on this saying: â€Å"If we died with Him we shall also live with Him. † Levels of adoptee’s acceptance View of adoption determines outcome (Borders et al. , 2007) No acknowledgement Denial No truth or healing Acknowledgement with questions Questioning Missing something Focus on Loss Angry Stuck in resentment Aware of both Loss and Gain Processing Moving Forward Peace Focus on Gain: New Life LIFE Orphan Son Image of God See God as Loving Father Independent/Self-reliant Dependency Interdependent Orphan Spirit Live by Law Theology Live by Love Insecure/ Lacks Peace Security Rest and Peace Strives for Man’s acceptance Need for Approval Accepted in God’s love and grace No Motivation or need to impressMotive for Service Service motivated by gratitude and love Self-rejection Counterfeit affections: addiction, escapism Competition Distrustful Self-Image Source of Comfort Relationships View of Authority Accusation and Exposure View of Other’s Faults Guarded and Conditional Expression of Love Conditional and Distant Bondage Servant/Slave Sense of God’s Presence Condition Position Positive and affirmed Resting in the Father’s Love/ Holy Spirit Humility and Unity Respectful; Honoring Love Covers Open, patient, affectionate, self-less, kind Close and Intimate Spirit of Adoption See God as MasterLiberty Son-ship Recognition for something Vision Receiving and Giving the Love of the Father Fight or Give up Future HOPE Frost, Jack and Trisha Shiloh Place Ministries Living as sons and daughters â€Å"Now you are no longer a slave but God's own child. And since you are his child, God has made you his heir. † Galatians 4:7 â€Å"He predestined us to be adopted as his sons through Jesus Christ, in accordance with his pleasure and will-† Romans 12:2 Helpful Steps to Living Loved Allow time to Grieve/Be Real Psalm 62:8 Trust in him at all times, O people; pour out your hearts to him, for God is our refuge.View Adoption as Good (Borders, et al. , 2007) Ephesians 1:5 He predestined us to be adopted as his sons through Jesus Christ, in accordance with his pleasure and will†¦ Renew our Minds according to the Word Romans 12:2 Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind Recognize and Resource The Family of God Eph. 4:16 From him the whole body, joined and held together by every supporting ligament, grows and builds itself up in love, as each part does its work. Acknowledge God’s truth, and have grace for process! Adopted into the Family Of God built up in Love† Both spirituality and surrounding relationships are orientating and motivating (Pargament, 2003) Participation in Church and its relational support system is protective of physical and mental health (Pargament, 2003) Forgiveness Grace Love Mercy â€Å"For this reason I bow my knees before the Father, from whom every family in heaven and on earth is named †¦ † (ESV) Ephesians 3:14-15 â€Å"You also, like living stones, are being built into a spiritual house to be a holy priesthood, offering spiritual sacrifices acceptable to God through Jesus Christ. † 1 Peter 2:5 (NIV) References . 2. 3. 4. 5. 6. Passmore, Nola L. (2004) Adoption and the Father Heart of God: helping adoptees deal with Issues of identity and loss. Journal of Psychology and Christianity, 23 (2). pp. 165-175. ISSN 0733-4273 Pargament, Kenneth, L. (2003). Advances in the Conceptualization and Measurement of Religion and Spirituality; Implications for physical and mental health research. American Psychological Association, 58 (1). 64–74. doi: 10. 1037/1941-1022. S. 1. 3. Penny, J. , Borders, L. , & Portnoy, F. (2007). Reconstruction of Adoption Issues: Delineation of Five Phases Among Adult Adoptees.Journal Of Counseling & Development, 85(1), 30-41. Frost, Jack and Trisha, Shiloh Place Ministries. www. shilohplace. org Johnson, D. E. , & Gunnar, M. R. (2011). IV. GROWTH FAILURE IN INSTITUTIONALIZED CHILDREN. Monographs Of The Society For Research In Child Development, 76(4), 92-126. doi:10. 1111/j. 1540-5834. 2011. 00629. Mark Meerum Terwogt, Caroline J. Meerum Terwogt-Reijnders, Suus M. J. van Hekkenn (2002). Identity problems related to absent genetic father http://www. zeitschrift-fuer-familienforschung. de/pdf/2002-3-terwogt. pdf

Broad Scholarship

Education is the key to all doors of the world. I know that by seeking my education I can help someone else benefit from it and also succeed in their life as well. My desire to obtain a degree is a representation to others that anything is possible if you put your mind to it. As a person who appreciates the opportunity to educate myself on all topics, not just one, I can never take that for granted.Many people who don’t have an education or those who cannot achieve it because of poverty or fear, I can be an inspiration to them, letting them know that receiving your education is not only about hard work and dedication, but that its fun and exciting at the same time. I can give the wisdom of knowing that nothing compares to learning something new and experiencing that knowledge first hand in the world.I tell the kids who I work along-side with everyday that going to school is fun. They see me going to school every day. I share stories of the high school lifestyle to them all the time. They know that by going to college you can be whatever you want and how you want to be presented to the world. You’re your own boss and they listen. They not only see the benefits from having education, but they know how having an education can lead to newer heights in their lives and also for their families lives.I believe by me getting my education, I can keep that hope among our younger generation for all eternality, one that will never perish, but only live with a smile of gratitude and appreciation for the word education. The dream of receiving an education will expand through their eyes and mine, bringing new dimension and understanding of education to the world as a whole for all people. This is why my degree is so important to me, for the better of our children’s children children.

The Giver3 essays

The Giver3 essays I think that the book The Giver by Lois Lowry is a book that shows that it isnt good to be perfect or live in a perfect world. You dont get to experience many things that you experience in regular life. One example from the book is how Jonas doesnt like the job that the elders assigned to him. He didnt know what he was supposed to do as a giver. He wished he had a regular job like his friends had. Id hate someone assigning me my job in the community. I would want to be able to pick my own role, even if we both agreed on the same thing. Another reason the book shows how perfection is not good is how the life is so dull in Jonass world. Nobody sees any color. In my opinion, color makes the world very beautiful. Everybody must follow strict laws. If a citizen does not abide by these rules, they are sent to prison and singled-out from the world. Also, they never meet anyone outside their town like regular people would at colleges or on vacation. Besides the festivals when kid s grow another year, nothing very exciting goes on in the towns. Most importantly, there was almost no point to living. The only things that they did were grow up, get a job, and own kids you didnt even give birth to. Your life is controlled by a group of people that you dont see too much of. You dont experience any strange feelings like excitement or jealousy. Also, I think that the most important source of learning for a person is learning from there own experiences. People should learn from their own experiences in real life, but people dont in Jonas world. As you can see, a perfect town or community isnt that good. The quest for perfection can cause many problems. ...

Marriage & Voyeurism in Rear Window essays

Marriage & Voyeurism in Rear Window essays All of the characters in Rear Window are described at one point or another in terms of their marital status and in terms of their relationships with the opposite sex. This represents a central theme in the film. The crime on which the plot pivots is the result of a failed marriage. The hero of the film, L.B. Jefferies, tosses the proposal of marriage around throughout the film despite his opposition to commitment. Like other Hitchcock movies, this one gives a gray light to marriage. The viewer sees Jeff's hesitance to get married for no real reason, as well as Thorwald1s miserable marriage to a wife who laughs at him after he brings her dinner in bed with a rose. From the Thorwalds, the institution of marriage looks like entrapment. Even the newlyweds have problems at the end of the movie. The wife says "I wouldn1t have married you if I had known you would quit your job," which seems like the beginning of trouble. Thus, the outlook of marriage is very negative. Examining this theme further, we can look at individual couples and examine the many parallels the film offers. To begin with, there are striking similarities between Jeff and Lisa's relationship and the Thorwalds. However, gender roles are reversed. Lisa and Lars strive for a peaceful and loving relationship with their partner, and are active and mobile. On the other hand, Jeff and Mrs. Thorwald are constant complainers confined to one place. The viewer is forced to question why Jeff and Lisa won1t end up just like the Thornwalds. Despite the parallels, there are differences. When Lisa climbs into Thorwald's apartment we finally see her do something significantly opposed by Jefferies, but this is when he is really turned on by her spunk and spontaneity. It is the turning point of the movie for their relationship. When caught by both Thorwald and the police, she offers a wedding ring on her finger to Jeff1s admiring gaze. She has solved the murder, found the key clue, an...

How To Drive a $221 ROI Using Promoted Content on Facebook

How To Drive a $221 ROI Using Promoted Content on Facebook How would you like to make $22 on every $1 spent promoting content? Sounds too good to be true, right? Well, let’s find out. Today, we’re talking to Freyja Spaven and Daniel Daines-Hutt, authors of How We Drive A $22:1 ROI From Cold Traffic, Using Facebook And Promoted Content. They share secrets to their success when it comes to researching, planning, designing, copywriting, and testing to promote content via paid ads on Facebook. AmpMyContent helps small business that have funds, but are time poor and unable to leverage content Tweaking content to make it 10X more effective Paid Ad Process: Ad goes to cold audience Drives them to piece of content Presents hyper-specific, next-step offer with a highly efficient lead magnet Over-inundation of content; 83.6 million new posts are published every month Facebook ads allow you to get a lot reach, without spending a lot of money Research: Push traffic to good, not bad content; determine if ad is profitable; and interview readers regarding a problem that needs a solution Avoid creating a lot of content that doesn’t highlight your expertise about a topic Ads start at a loss; use bottom-up testing to make ads profitable Create an ideal audience for your content to make an ad that resonates with them Supply and Demand: More specific your ads, the more Facebook charges How people consume a newsfeed ad; on auto-pilot with their attention, interest Use Facebook machine learning to your advantage to obtain user data and create an algorithm to achieve conversion goals Branded Solution: Ad content should educate readers about specific systems and processes that reduce stress and solve relevant problems Getting people into a room, but not offering them anything; every piece of content should have a call to action Email is an effective channel to make sales Links: The Definitive Guide to Paid Content Promotion: Facebook Edition How to Create Killer Content That Gets Results In Any Industry AmpMyContent Freyja Spaven on Twitter Daniel Daines-Hutt on Twitter The 10X Marketing Formula by Garrett Moon Mad Men Machine Learning Facebook What topics and guests do you want on the Actionable Marketing Podcast? Send me your suggestions! If you liked today’s show, please subscribe on iTunes to The Actionable Content Marketing Podcast! The podcast is also available on SoundCloud, Stitcher, and Google Play. Quotes: â€Å"There are so many benefits to promoting content, rather than just writing new stuff all the time.† Daniel Daines-Hutt â€Å"It’s a very simple process. Like everything when it comes to marketing, it’s the subtleties.† Daniel Daines-Hutt â€Å"Marketing really is connecting someone from A to B, from their problem to the solution.† Daniel Daines-Hutt â€Å"One of the big mistakes that we see is people creating a great breadth of content and not really showing their expertise in their content by going deep into a subject.† Freyja Spaven

For the Love of Water Essay Example | Topics and Well Written Essays - 1000 words

For the Love of Water - Essay Example Major bodies and political institutes have gained control over the water distribution channels of the world and are making a lot of money at the expense of the poor persons. Water has now turned into an expensive commodity that can only be afforded by the well off while the rest have to do with spring water, or even dirty ditch water. Positive and negative externalities There are positive and negative externalities as far as water supply is concerned. The positive externalities are; the suppliers of the water are making millions as the commodity is in demand since we cannot do without water. It is the big corporations that are gaining from this business. These corporations are headed by persons who are believed to be associated with the World Bank. So as the World Bank imposes regulations on countries concerning the privatization of water supply then these corporations cash in. Privatization Privatization being the transfer of the ownership or business title to the private sector has turned the water supply system into a mess. Initially as the governments would supply water through their own ministries, there was sanity in the industry. As time went by, pressures have been exerted especially on the developing countries to privatize the water supply systems. Initially, the private sectors made the people believe that they were out to help them have water supply but this was not the case. It is common sense that as these companies supply water, they are in business and would want to make an extra coin for their investors. Privatization was meant to equip the cities with portable water and sewerage which did happen but only to those people who could afford the change. A lot of people who earn very little couldn’t afford the change and thus have to do with well water or borehole water where available. In other places in the world, the private sector connected water then charged for the water supply or consumption that people use. When these people are not ab le to pay for the water, it is cut off. These people have now turned rebellious and are reconnecting the pipes themselves to get the water. Some do this in the night. Advantages of privatization. Privatization though considered a bad omen by the people especially of the developing countries has its own advantages though not many. It has created employment as these corporations set up firms in these countries to supply water. These firms also contract persons to do the piping and sewerage construction, thereby creating money making avenues for the people on the ground. With the coming of the pipe water, it is believed that the rate of people getting water borne diseases was reduced as these water supplying corporations cleaned and disinfected the water. According to FLOW (2013) bad and infected water kills more than even AIDS and other diseases. Privatization was also a God sent blessing to the water bottling companies as the rate at which people are taking bottled water is very high and it created a booming business. To the people that were able to pay, sewerage and piped water is a blessing as compared to fetching water at a river or borehole. Disadvantages of privatization With these advantages came many disadvantages. People are excluded from portable water in cities. They don’t have water nor the money to buy the basic commodity. The kind of wages that these people get cannot allow them to have all the water that they would require to live healthy lives. They have to make do with very little water and do all they need to with this. What they can do away with like bathing daily, and cleaning their clothes, they don’t do on a daily basis but just when it is really necessary. The private water suppliers have neglected them. For these suppliers it is just

Emigration Essay Example | Topics and Well Written Essays - 750 words - 1

Emigration - Essay Example In 2011 alone, the United States, which has the largest number of immigrants in the world, received 87,000 permanent residents from China (â€Å"Wary Future, Professionals Leave China†). Consequently, the increasing number of immigrants has resulted to a number of research studies to understand this phenomenon. One effective way to understand the concept of emigration in the present time is to examine its causes. People emigrate for various reasons, but the most common causes are education, employment, freedom, and war. These causes are the prime motivation for people around the world to emigrate to other countries. Education, which is a product of globalization, is one of the leading causes of emigration. Globalization has pushed immigrant children to move to the first world countries like the United States to obtain their education. People seek for a better quality of education for them to be globally competitive and hirable in their own chosen fields. Education in the form of research and development is another result of globalization. Academicians accomplish their research studies in other countries where they are able to utilize more advanced facilities and technological equipments to get better results. Scholarships also largely contribute to the number of immigrants in the academe. It enables immigrants to avail low cost and yet high quality education through scholarships. Employment is another leading reason for emigration as people in poor countries work overseas. As developed countries have good economic conditions, industries in these countries offer much higher salaries than poor countries do. In addition, the worker’s rights and benefits are top priorities for these countries as developed countries have more stable policies that protect employees’ welfare. Lastly, these countries have high employment rate that means that they offer many job opportunities. Other people emigrate to find more freedom in the things that

Article review on war affairs relating to foreign policy

Review on war affairs relating to foreign policy - Article Example This is because of the Budapest Memorandum, as a foreign policy pact for Ukraine to cease the world’s third largest nuclear potential in exchange for peace, but Russia one of the countries that vowed to provide peace is taking it away. Foreign policy development should be in a position to address such backstabbing in future policy agreements. Foreign policy development also hinged on the article’s theory is to ensure the effectiveness of economic sanctions in deterring evil as demonstrated by the inversion of Russia and threat to use nuclear weapons. This is a deviance from previous foreign policy agreements resulting in the need to develop policy to respond to this theoretical issue presented in the article. The other development of foreign policy analysis evident from the theory in the article is the need for the development of proactive and not reactive foreign policies to guard against foreign aggression evidenced by Russia’s inversion of Ukraine. The arguments in the article are persuasive, for example, the argument for the need to prevent the use of nuclear weapons by Russia as this will result in China and Korea following suit. The realization that the agreement for use of nuclear weapons for defensive use only by Russia will make these other countries follow the same to intimidate and pursue their own selfish interests not regarding the impact on other economies. The other argument in the article is breaking of the treaty outlawing the use and testing of cruise and ballistic missiles ranging between 300 and 3400 miles that form the main foundation of the postwar peace. The argument is persuasive because Russia began withdrawing from the treaty t cruise and ballistic missiles of 300 to 3400 ranges showing that the argument holds some ground. The other ground for the argument to be true is that since 2008, Russia has been testing cruise and ballistic missiles of the ranges disallowed by the treaty. I would critic the

Electronic Displays Essay Example | Topics and Well Written Essays - 2000 words

Electronic Displays - Essay Example Electronic paper is a more recent electronic display technology (Facchetti and Marks 2010, p213). Cathode Ray Tube (CRT) CRT is a vacuum tube that uses a hot filament to produce electrostatic, magnetic fields, and thermo-electrons to â€Å"focus the electrons into a beam attracted to the high voltage anode which is the phosphor emit luminous radiation† (Maxim Integrated Products 2002, p1). Color CRTs generally utilize three electron sources or guns to target blue, green, and red phosphor prototypes to the screen. Electro-Luminescent Display (ELD) EL display is a solid-state display that uses phosphor to discharge light or a beam in the presence of an electric field. Phosphors utilized are generally green or yellow-orange (Maxim Integrated Products 2002, p1). Flip-Dot Display Each pixel is composed of a hinged disk. The disk is characterized by a reflective or a fluorescent (lit) on one side and a matt black on the other side (unlit). Various methods are used to flip the disk. One technique balances the disk around the electromagnetic soft iron framework. The winding is strengthened to attract the disk towards either of the sides. The remanent magnetism grasps the position and thus, only a small amount of energy (power pulse) is needed to flip the pixel. Incandescent Display (Light Bulb) A tungsten filament (which is coated) is run white hot in the vacuum. The filament generates both infrared (heat) and visible light. Liquid Crystal Display (LCD) LCD utilizes the liquid crystals properties in an electric field to direct light from the opposite polarized back and front display plates. The liquid crystal functions as a helical director to direct the light or beam through 90 degrees from one plate to the other plate. It is important to note that the liquid crystal acts as a director only when the driver gives the correct electric field (Maxim Integrated Products 2002, p2). Light Emitting Diode (LED) LED is a photon generating semiconductor, which generates l ight due to the effect of injection electroluminescence. The emitted light wavelength varies primarily because of the semiconductor material chosen and it is generally in infrared or a visible spectrum. Organic LEDs (OLED) Polymer LEDs (PLED) These forms of display utilize organic electroluminescent materials placed on flexible or a glass substrate. OLEDs are devices dependent on small organic polymer molecules and PLEDs are devices based on the large organic polymer molecules. Light is emitted through injection electroluminescence just like LEDs. The â€Å"choice of organic material sets the emission color OLED pixels are capacitive (tens to hundreds of pictofarads) leading to significant switching losses for large displays with high multiplex ratios† (Maxim Integrated Products 2002, p3). Glow Discharge (Plasma) Indicators (Nixie) Inert gas within a tube (the tube is composed of two electrodes under high voltage) is ionized permitting current to emerge around the cathode. Wh en the tube is driven from an alternating current (AC) source such as a neon indicator, the glow discharge emerges from both electrodes. Sophisticated displays utilize either multiple cathodes designed as complete numerals (each lit at a time) or segments (a character

The Culture and History of Switzerland Assignment

The Culture and History of Switzerland - Assignment Example The main principle that characterizes the country’s political system is that the citizens have the highest political authority in the states of Swiss. They have the leverage of conveying their opinion at the levels such as communal, cantonal, and federal. Moreover, they can not only vote on different issues but also elect representatives of the Federal Assembly (Swiss Community, 2015). Response to question 3 The geopolitics and geography of the Swiss sustained and allowed a tension-laden but polycentricity that was effective. The cantons stubbornly, on autonomy, canalized the attempts, as well as, state-building into a league mode of association instead of centralizing the unitary state model. The ultimate sovereignty neither depends on the citizen nor in some of the central universal principle though it will depend on the autonomous communities. This can be explained by the difference of in the democratic process of this country in comparison to other democracies. It has a direct democracy where the citizens influence government activities directly through either referenda or initiatives. In the federalism, the constitutional powers are citizen centered as well as the cantons. Moreover, they have consociational democracy where the cantonal majority rules. Cantons that are small have equal weight to those that are big (Swiss Community, 2015). Response to question 4 In my opinion, the culture and color character of the Zurich, Geneva, and Basel relatively differ. This can be attributed to the fact that the culture of the citizens is firmly anchored by the cantons. These cities are important facets of cultural identity as they contribute to the cultural and social substance towards the maintenance of the nation that is polycentric.

Scholarly Paper in APA Format Research Example | Topics and Well Written Essays - 750 words

Scholarly in APA Format - Research Paper Example In this section it states that the crux of this study is to have an idea between the perception of a nursing home staff about organizational processes like communication, teamwork, and leadership with the characteristics of NHA and DON like turnover, tenure and educational preparation. In order to set its ground of research, the authors have provided findings of existing literatures in the relevant field of study using proper APA format. Analysis of Method: In this section the authors elaborately discussed the method that they used for their empirical study. Forbes-Thompson et al (2006) used a cross-sectional design for their descriptive study. In the first survey, the total number of respondents was 3,894 staff and for the second survey, the combined sample included 261 administrative staff and 1,463 care staff. In this study, the characteristics of leadership in a nursing home were examined in terms of tenure, turnover, and educational preparation of the NHA and DON. The tenure inc luded two variables - the number of years in the current position and the number of years of experience in prior nursing homes. ... The survey conducted by two third percent of DON held less than a baccalaureate degree and it did not influence the ratings of staff communication, teamwork, and leadership. The findings from this study highlighted the need to explore differences in perceptions between administrative and direct care staff and the way it can or cannot influence the staff development and quality improvement activities in nursing homes. Analysis of Dicussion: In this paper discussion part directly followed the result part. It interpreted the results and related them to the findings of exiting studies and provided the implications of the results. The findings of Forbes-Thompson (2006) had implications for corporations and upper level managers who used firing as a solution for negative survey outcomes or who do not adequately rewarded their administrative teams. However, the study did not mention any limitations of it which is essential in a APA formatted scholarary paper., Analysis of Article 2: Explorin g the Influence of the Regulatory Survey Process on Nursing Home Administrator Job Satisfaction and Job Seeking.† by Terry Holecek, Mary Dellmann-Jenkins, and Dale Curry. Analysis of abstract: This paper has a properly formatted abstract part that provide its purpose in brief along with methodology and findings in a succinct way. Analysis of introduction: The study aimed at whether factors like regulatory process perceptions, survey performance like the number of deficiency citations on last survey, and demographic or facility variables helped to determine the degree of job satisfaction and job seeking attribute of administrative leaders in nursing homes. Analysis of method: This part is also formatted using APA guidelines. Holecek, Dellmann-Jenkins and

The Culture and History of Switzerland Assignment

The Culture and History of Switzerland - Assignment Example The main principle that characterizes the country’s political system is that the citizens have the highest political authority in the states of Swiss. They have the leverage of conveying their opinion at the levels such as communal, cantonal, and federal. Moreover, they can not only vote on different issues but also elect representatives of the Federal Assembly (Swiss Community, 2015). Response to question 3 The geopolitics and geography of the Swiss sustained and allowed a tension-laden but polycentricity that was effective. The cantons stubbornly, on autonomy, canalized the attempts, as well as, state-building into a league mode of association instead of centralizing the unitary state model. The ultimate sovereignty neither depends on the citizen nor in some of the central universal principle though it will depend on the autonomous communities. This can be explained by the difference of in the democratic process of this country in comparison to other democracies. It has a direct democracy where the citizens influence government activities directly through either referenda or initiatives. In the federalism, the constitutional powers are citizen centered as well as the cantons. Moreover, they have consociational democracy where the cantonal majority rules. Cantons that are small have equal weight to those that are big (Swiss Community, 2015). Response to question 4 In my opinion, the culture and color character of the Zurich, Geneva, and Basel relatively differ. This can be attributed to the fact that the culture of the citizens is firmly anchored by the cantons. These cities are important facets of cultural identity as they contribute to the cultural and social substance towards the maintenance of the nation that is polycentric.

Irony in to Kill a Mockingbird Essay Example for Free

Irony in to Kill a Mockingbird Essay Irony: A rhetorical device, literary technique, or situation in which there is an incongruity between the literal and the implied meaning. Example: â€Å"’We are a democracy and Germany is a dictatorship†¦ Over here we don’t believe in persecuting anybody. Persecution comes from people who are prejudiced’† (329). Lee, To Kill A Mockingbird. Context: In To Kill A Mockingbird, by Harper Lee, during class, little Cecil Jacobs gives his current event about Adolf Hitler to the class. Miss Gates, the teacher, takes this opportunity to teach the children a lesson about how wrong prosecuting the Jews was and how she â€Å"hate Hitler so bad† (331). Scout later finds this misleading because at the courthouse, she overheard Miss Gates telling Miss Stephanie â€Å"’it’s time somebody taught [black people] a lesson, they were getting’ way above themselves’† (331). Concept: In To Kill A Mockingbird, Lee utilizes irony to emphasize the connection between the issue of racism in Maycomb to Hitler’s intolerance for Jews. Lee applies the reference to Adolf Hitler as a representation of the discrimination in Maycomb. During a lesson, Miss Gates expresses her belief of how it was horribly erroneous Hitler’s injustice to the Jews was. Although she believes â€Å"‘[in Maycomb], we don’t believe in persecuting anybody’,† she is oblivious to the prejudice she is against because it was fairly distinct in the aftermath of Tom Robinson’s trial, that the town, in fact, does commit the act of aversion towards black people (329). Scout recalls Miss Gates telling Miss Stephanie in the courthouse after Tom Robinson’s trial, that â€Å"it’s time somebody taught [the black people] a lesson’† (331). Miss Gates contradicts herself by teaching the children a lesson about the detestable acts of persecution while she hypocritically judges the blacks harshly right in Maycomb. She herself is mirroring the actions of Hitler, persecuting the black people in her own town when she herself says that the people of Maycomb â€Å"don’t believe in persecuting anybody† (329). It is ironic because Miss Gates has these views on Hitler whereas her actions are comparable to Hitler’s. Connection: In To Kill A Mockingbird, the above example links to the characterization of the Maycomb townspeople. Their hostility reveals a darker, more lurid side to the seemingly peaceful town. The biased townspeople are very discriminating to the black people. Their hateful ways show ignorance and how they rule the community’s concept of what democracy means. When Atticus says that Tom Robinson’s case â€Å"is as simple as black and white,† he literally means it is that simple. The white people easily side with Bob Ewell’s story rather than with the truth just because it is a black man’s words. This displays their prejudice and animosity against black people.

Example Medicolegal Report

Example Medicolegal Report MEDICOLEGAL REPORT Prepared for the Court Claimant:Mrs A Address:Unspecified Date of Birth:1958 Occupation:Housewife Date of Accident:15 February 2005 Examining Doctor:Dr D Consultant Obstetrician and Gynaecologist Statement of Instruction This report is prepared on behalf of the defendant, Dr D in connection with the complications following treatment of Endometriosis on Mrs A started from 23 April 2003. Case Summary Mrs A has suffered complications from foecal peritonitis and pulmonary embolism following the procedures of total abdominal hysterectomy and bilateral salpingo-oophorectomy for the treatment of endometriosis. Case Details Mrs A was referred by her GP and attended the clinic on 23rd April 2003. Mrs A was complaining of constant, severe abdominal pain, per vaginal bleeding with irregular cycles for 2 months with a background history of tubal ligation in 1999. Dr D was unsure of the diagnosis as to whether it was due to endometriosis, polycystic ovarian disease, or tubal infection associated with the previous tubal ligation. Therefore Mrs A was admitted, prescribed with painkiller (Pethidine), and booked for laparoscopy the next day. The result of laparoscopy confirmed active endometriosis with 2 small fibroids and medical treatment of GnRH analogue (Zoladex) was discussed with Mrs A and agreed. Mrs A treatment was then to be reviewed in November 2003. On 5th November 2003, Mrs A attended the clinic and her medication was changed from GnRH analogue to Medroxyprogesterone acetate (Provera). On review in 4th February 2004, Mrs A was not happy with Provera and the prescription was reverted back to Zoladex. On review in 14th July 2004, side effects due to prolonged use of Zoladex were explained and she agreed to start on combined oral contraceptive pills (COCP). On 24th Novemeber 2014, Mrs A came in complaining of severe pain not resolved with COCP and painkiller. Surgical treatment was discussed and she was booked for operation for the removal of uterus, cervix, Fallopian tubes, and ovaries called â€Å"Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (TAH/BSO)† in February 2005 and for the meanwhile she was also prescribed with non-steroidal anti-inflammatory drug Mefenamic acid (Ponstan) and an opioid analgesics tramadol (Zydol) to relieve the pain. On 15th February 2005, Mrs A was admitted to the hospital for TAH/BSO. On 16th February 2005, Mrs A complained of pleuritic chest pain, shortness of breath, fever, and sweating. On examination she was tachycardic, and on auscultation, there were coarse crackles on the right base of the lung and fine crackles on the left base. She was commenced on antibiiotics without delay – ciprofloxacin and gentamycin together with an anticoagulant low molecular weight heparin – Innohep post-surgery. On 17th February 2005, CT pulmonary angiogram confirmed pulmonary embolism on the right side with possibility on the left side. She was commenced on warfarin and Innohep was continued until INR stabilized. On 18th February 2005, Mrs A complained of non-pleuritic chest pain, numbness going down on the left arm and up into the neck, and tenderness over the left axilla. Cultures showed positive Gram negative coccobacili. Antibiotics treatment was continued and respiratory consult was obtained. On 21st February 2005, cultures showed anaerobic organism that usually comes from the gut – Prevotella loescheii. The antibiotic course was changed to include metronidazole. On 23rd February 2005, radiology report confirmed the diagnosis of foecal peritonitis. Stomatherapy was discussed and anaesthetic consult was obtained. This was day 9 post-TAH/BSO and Hartmann procedure was done to treat the peritonitis. On 24th February 2005, antibiotic treatment of cephalosporin (Cephradine), metronidazole, and gentamycin were continued. The Results of Investigation Mrs A was diagnosed endometriosis through laparoscopy and 2 small fibroids were also found. It was confirmed from the histopathology report. Pulmonary embolism was diagnosed through radiological findings on CTPA and increased in D-dimer while sepsis was identified from the blood culture. Peritonitis was suspected from the finding of anaerobes on culture and clinical signs and symptoms together with CT scan of the abdomen formed the diagnosis of foecal peritonitis. The Nature of Treatments Received by the Claimant Endometriosis When Mrs A first diagnosed with endometriosis, she was treated by medical treatments – GnRH analogue for 6 months, then changed to Medroxyprogesterone for the next 4 months, back to GnRH analogue for another 6 months afterwards, and changed to Combined OCP. Mrs A condition was getting worse and surgical option of TAH/BSO was decided. Pulmonary Embolism (PE) and Sepsis Mrs A was prescribed with antibiotics and anticoagulant when lower respiratory tract infection or PE was suspected. When PE was confirmed, she was already on anticoagulant (Innohep). Warfarin was prescribed after the diagnosis made and antibiotics were continued due to suspected pneumonia or sepsis. The next day, blood culture result was out and confirmed positive. Peritonitis Mrs A was suspected of having sepsis and once culture showed the presence of anaerobes from the gut (Prevatella loescheii), metronidazole was prescribed to cover the anaerobic bacteria. When bowel perforation and foecal peritonitis were confirmed, surgery was carried out to clean up the abdominal cavity. Antibiotics, painkiller, and anticoagulant were continued post-surgery. Opinion on the Patient Management It was a regretful incident that Mrs A suffered complication from peritonitis secondary to bowel perforation, either secondary to adverse event where the operating surgeon unintentionally cut the bowel or due to advanced endometriosis. My review of the managements of this patient from her initial presentation of endometriosis are they are evidence-based, performed in a timely manner, and displayed the knowledge and action of an experienced clinician, and that the complications aroused were less likely due to poor management of the patient. In 1999, Mrs A underwent a laparoscopic tubal ligation and during the operation, there was suspected retrograde menstruation found which may possibly suggest endometriosis. It was in 2003 that the patient was actually diagnosed with endometriosis. However, this could be common where there was delay between the onset of symptoms and the diagnosis of the disease. There is no difference in the delay in diagnosis between mild to moderate and severe endometriosis. In a comparison study conducted in UK and US, the average delay before the diagnosis of endometriosis was 7.5 years and this will likely decreases the women’s capability to cope with the symptoms in which they would present to the formal healthcare [Ruth Hadfield, 1996]. The clinical evaluation of Mrs A was done in a sufficient and timely manner as the diagnosis of endometriosis was suspected in the first presentation since this will usually require high index suspicion due to the wide variety of symptoms and unpredictable course of disease (Lobo, 2007). Video-assisted laparoscopy was also carried out in the second day of admission showing that the clinician involved has a very high suspicion index of endometriosis from the beginning, as laparoscopy is the gold standard to reach a definitive diagnosis of endometriosis. [Bagan et al, 2003] The approach of the management of endometriosis was done properly and the choice of medical treatment as opposed to surgical treatment is wise. Unlike surgery for cancer, Adamson GD (1997) and Sutton et al (1997) said that in the case of endometriosis, surgery is relatively more effective for severe endometriosis rather than in mild cases such as in those with chronic pelvic pain and infertility and because of that, medical treatment is much preferable in the first presentation of endometriosis apart from it being non-invasive. A Canadian study of more than 53 000 admissions showed that 25% patients who had surgical treatment would need another surgery within 4 years and 10% would require hysterectomy and therefore, continual medical management is much preferred over serial surgeries [Weir et al, 2005]. Alifano (2003) mentioned that the prescription of GnRH analogue is recommended as it may have both diagnostic and therapeutic values. The prescription of not more than 6 months in this case was also supported by clinical literatures and Royal College of Obstetrician and Gynaecology (RCOG) guideline as the treatment may result in loss of 6% bone mineral density in the first 6 months [RCOG, 2006]. Extended treatment may result in further loss of bone minerals. Falcone (2011) recommended the commencement of combined oral contraceptive pills (COCP) following the cessation of GnRH analogue and therefore, the choice of COCP after GnRH analogue in this case was also supported by clinical evidence. Shakiba et al (2008) also described the usage of COCP as cost-effective, well tolerated, and clinically effective as danazol and GnRH analogue. The medical treatment is initially acceptable for this patient as earlier laparoscopy in June 2003 showed adhesions between the omentum and uterus with multiple spots of endometriosis and thick, stale, reddish green blood while the later microscopy findings in February 2005 showed well bordered white lesion and occasional white coloured spots that may be suggestive of healed or inactive lesions which should reduce the likelihood of invasive treatment. Brosens (1994) believed that the early and very active lesion would be in red, active and advanced lesion in black, and inactive or healed lesion in white, even though this might be varied from case to case. It is worth to note that there is currently no cure for endometriosis as current treatments aim at symptoms relief such as pain and infertility and organ damage prevention in severe cases. There is no randomized clinical trial comparing medical with surgical treatments; therefore the change of medical to surgical treatment has its own advantages and disadvantages [Sally et al, 2013]. From the record, there was a gap between the patient presentation of severe pain not improving with painkiller and COCP to the last clinic before surgery in November 2004 and the booked surgery in February 2005. This may be justified by non-invasive over invasive management; for example managing the pain by prescribing stronger painkiller such as in this case, tramadol. Since there is no relationship between the severity of pain with the severity of endometriosis, short delay in deciding on hysterectomy or watchful waiting may be an advantage for the patient and the clinician as well to see if there woul d be any improvement. Apart from that, there was no guarantee that surgery may treat the endometriosis. The decision of TAH/BSO was also recommended in this case as the preservation of one or both ovaries in some women may have left the problems with endometriosis behind. Whether the hysterectomy being subtotal or total, it would definitely improve the quality of life of this patient and thus should be considerable decision by the clinician. [Thakar et al, 2004] Even though all precautions and preventive measures have been made, while incidence of internal organ injury is rare, however it does happen especially when the risk is higher in the patient with history of pelvic infection, endometriosis, and adhesive diseases [John, 1997]. However, considerations that need to be taken into account is whether the complications aroused were due to an adverse event such as bowel perforation from the surgery, expected complication arising from the condition such as secondary to adhesions from endometriosis, or the combination of both. The risk of bowel perforation in this open abdominal surgery is much lowered compared to scope-assisted hysterectomy. Bowel injuries happen in about 0.2-1% of cases and primarily due to adhesions involving bowel or cutting within the pouch of Douglas – the space between rectum and uterus. Therefore, it was difficult to expect that this case was to be an addition to the 0.2-1% risk in the study. (Gary et al, 2004) Infection is a common complication following abdominal hysterectomy carrying the risk of 6-25%. Above all, about 33% of patients develop infection after the operation regardless of careful precautions taken [Rice et al, 2006]. Other than infection, severe complications that may occur involve lung collapse, heart attack, stroke, kidney failure, and clotting in the blood vessel (ie pulmonary embolism- clot blockage in the lung) with 4% risk. Greer (1997) mentioned that the risk of developing pulmonary embolism in patient following major general or gynaecologic surgery without clot prevention treatment (thromboprophylaxis) is very low at 0.2-0.9% while in another study, the risk of pulmonary embolism for patient receiving clot prevention treatment of anticoagulants is 0.2%. Therefore, this is a rare severe complication of abdominal hysterectomy that less expected to happen. Despite psychological effects following hysterectomy and prolonged hospitalisation, patient has benefit from the improvement in the quality of life in longer term. And even though multiple complications resulted from the procedure, most women are quite satisfied with the results of the surgery and with the significant symptom relief they experience [Kjerulff et al, 2000]. Conclusion Complications after surgery despite their rareness does happen and this was unexpected incident befall upon Mrs A. However, I believed Dr D, within his capabilities, has managed Mrs A with acceptable, sufficient, and evidence-based methods from the initial treatment until the last resort of hysterectomy to prevent any complications from happening. Duty of an Expert I understand my duty is to the Court; to help the Court on matters within my expertise, and I have complied with that. I understand that this duty over-rides any obligations to those by whom I have been instructed. I believe that the facts I have stated in the report are true and within my own knowledge and that the opinions I have expressed represent my professional opinion. BIBLIOGRAPHY Brosens I. Is mild endometriosis a progressive disease? Human Reproduction 1994; 9: 2209–2211. Adamson GD. Treatment of endometriosis-associated infertility. Seminars in Reproductive Endocrinology 1997; 15: 263–271. Sutton CJG, Pooley AS Ewen SP. Follow-up report on a randomized, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertility and Sterility 1997; 68: 170–174. AstraZeneca. Zoladex 3.6mg Implant. Summary of Product characteristics. 2012. Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD008475. Falcone T. Lebovic DI. Clinical management of endometriosis. Obstetrics Gynecology. 118(3):691-705, 2011 Sep. RCOG. The investigation and management of endometriosis. Green-top guideline 24. 2006 Lobo R. Endometriosis: Etiology, Pathology, Diagnosis and Management. 5th ed. Katz VL, editor. Comprehensive Gynecology. Philadelphia, PA: Mosby Elsevier; 2007:473–499. Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. Chest. 2003;124:1004–1008. Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg. 2003;75:378–81; discusssion 81. Weir E, Mustard C, Cohen M, Kung R. Endometriosis: What is the risk of hospital admission, readmission, and major surgical intervention? J Minim Invasive Gynecol 2005;12:486–93. Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow up on the requirement for further surgery. Obstet Gynecol 2008;111: 1285–92. John D Thompson. Operative Injuries to the Ureter: Prevention, Recognition, and Management. In: John A Rock and John D Thompson. Te Lindes Operative Gynecology. Eighth. Philadelphia New York: Lippincott-Raven; 1997:Chapter 40 Pages 1135-1173. Thakar R, Ayers S, Georgakapolou A, Clarkson P, Stanton S, Manyonda I. Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy. BJOG. Oct 2004;111(10):1115-20. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. Jun 1997;24(2):235-258. Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. BJOG. Nov 2004;111(11):1204-1212. Ruth H, Helen M, David B, Stephen K. Delay in diagnosis of endometriosis: a survey of women from the USA and the UK. Human Reproduction; 1996: vol.11 no.4 pages 878-880. Kjerulff KH, Langenberg PW, Rhodes JC, et al. Effectiveness of hysterectomy. Obstet Gynecol. 2000;95:319-326. Rice CN, Howard CH. Complications of hysterectomy. US Pharm. 2006; 31(9):HS-16-HS-24. Greer IA. Epidemiology, risk factors and prophylaxis of venous thrombo-embolism in obstetrics and gynaecology. Baillieres Clin Obstet Gynaecol 1997; 11:403. Garry R, Fountain J, Mason S, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 2004; 328:129. Mà ¤kinen J, Johansson J, Tomà ¡s C, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001; 16:1473.

Edgar Allen Poe and Humor Essay -- Edgar Allen Poe Humorous Essays

Edgar Allen Poe and Humor Edgar Allen Poe is most often recognized, and certainly most famous, for his poem â€Å"The Raven† as well as other decidedly dark and often gothic poems and stories, stories such as â€Å"The Fall of the House of Usher,† â€Å"The Telltale Heart† â€Å"The Cask of Amontillado.† He also wrote many others mostly involving rather macabre, dark topics and characters as well as heavy themes such as insanity, madness, incest, murder and revenge. While this reputation is certainly well earned there is another side of Poe that is not quite so obvious. Poe was also a master of humor, especially in the use of parody and satire. One might ask how is it that a writer with such an inclination towards the darker side of humanity can possibly write humorously, and do it with such skill. Poe’s brand of humor is decidedly different than that which the mainstream contemporary audience is used to and can readily understand, but it is there if one cares to look cl osely. The style of Poe’s humor is not like that of the mainstream humorous writers in that he does not use the common comic strategies, but he instead â€Å"was able to turn his wit on the masses of society or their rulers with trenchantly satiric effect† by creating situations so ridiculous and outrageous that it becomes hysterical (Budd 133). Or as John Bryant says â€Å"he was a satirist specializing in burlesque, parody, and hoax. Humor was not his style, nor benevolence his manner; †¦ Poe’s barbed humorous stories are driven by caricature rather than character† (88). Some of Poe’s more humorous stories are â€Å"How to Write a Blackwood Article,† and â€Å"A Predicament,† and maybe not so obviously â€Å"The Murders in the Rue Morgue.† In a close look at â€Å"How to Write a Blackwoo... ...er because â€Å"his well known theory of the short story consistently emphasizes the importance of each and every detail in constructing the effect that †¦ an author of a short story has to have clearly in mind before beginning the task of composition† (Haugen 102). It may not be what the casual reader of Poe is expecting, or even wanting, but it is exactly what Poe intended and in truth that is what makes it humorous. Works Cited Bryant, John. Melville and Repose: The Rhetoric of Humor in the American Renaissance. New York: Oxford University Press, 1993. Budd, Louis J, and Edwin H. Cady, eds. On Poe. Durham: Duke University Press, 1993. Haugen, Hayley Mitchell, eds. Readings on: The Short Stories of Edgar Allan Poe. San Diego: Greenhaven Press, Inc.2001. Poe, Edgar Allan. The Complete Tales and Poems of Edgar Allan Poe. New York: Vintage Books, 1975.

Immigraton Laws Essay -- essays research papers fc

Immigraton Laws The first immigrants to the territory now the United States were from Western Europe. The first great migration began early in the 19th century when large numbers of Europeans left their homelands to escape the economic hardships resulting from the transformation of industry by the factory system and the simultaneous shift from small-scale to large-scale farming. At the same time, conflict, political oppression, and religious persecution caused a great many Europeans to seek freedom and security in the U.S. The century following 1820 may be divided into three periods of immigration to the U.S. During the first period, from 1820 to 1860, most of the immigrants came from Great Britain, Ireland, and western Germany. In the second period, from 1860 to 1890, those countries continued to supply a majority of the immigrants; the Scandinavian nations provided a substantial minority. Afterwards the proportion of immigrants from northern and Western Europe declined rapidly. In the final period, from 1890 to 1910, fewer than one-third of the immigrants came from these areas. The majority of the immigrants were natives of Southern and Eastern Europe, with immigrants from Austria, Hungary, Italy, and Russia constituting more than half of the total. Until World War I, immigration had generally increased in volume every year. From 1905 to 1914 an average of more than a million immigrants entered the U.S. every year. With the start of the war, the volume declined sharply, and the annual average from 1915 to 1918 was little more than 250,000. In 1921 the number again rose; 800,000 immigrants were admitted. Thereafter the number declined in response to new conditions in Europe and to the limitations established by U.S. law. The first measure restricting immigration enacted by Congress was a law in 1862 banning American vessels from transporting Chinese immigrants to the U.S.; 20 years later Congress passed the Chinese Exclusion Act excluding Chinese immigrants.(Immigration) In 1875, 1882, and 1892, acts passed by Congress provided for the examination of immigrants and for the exclusion from the U.S. of convicts, polygamists, prostitutes, persons suffering from contagious diseases, and persons liable to become public charges. The Alien Contract Labor Laws of 1885, 1887, 1888, and 1891 prohibited the immigration to the U.S. of persons entering the country t... ...ion (Rumbaut, 617). Despite evidence to the contrary, many Americans still believe immigration to be harmful. This is simply not the case. As stated, legal immigrants provide a benefit not only to themselves, but also to native people. Though the problem of illegal immigration must be addressed, it should be done in such a way as not to discourage legal immigration. America was founded and populated by people from other countries. We must continue this if we expect to survive in the 21st century. BIBLIOGRAPHY Blotnick, Srully. "Unleashed (Immigrant Professionals)." Forbes 26 Jan. 1987: 108. Mandel, Michael J. "The Immigrants: How They are Helping to Revitalize the U.S. Economy." Business Week 13 July 1992: 114-18. "Immigration," Microsoft (R) Encarta. Copyright (c) 1994 Microsoft Corporation. Copyright (c) 1994 Funk & Wagnall's Corporation. "Pending Legislation", www.usbc.org/surveys/npg-poll.htm Rumbaut, Ruben, "Origins and Destinies: Immigration to the United States since World War II," Sociological Forum 9:4 (1994), pp. 583-621. "The New Americans: Yes, They'll Fit in too." The Economist 11 May 1991: 17-20.